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Calif. Strike Highlights Larger Issues With Mental Health System

NPR Health Blog - Sun, 01/18/2015 - 4:57pm
Calif. Strike Highlights Larger Issues With Mental Health System January 18, 2015 4:57 PM ET NPR Staff Listen to the Story 4 min 51 sec  

A Kaiser mental health worker with the National Union of Healthcare Workers looks through a pile of signs Monday during day one of a week-long demonstration outside of a Kaiser Permanente hospital in San Francisco.

Justin Sullivan/Getty Images

This past week, more than 2,000 mental health workers for the HMO health care giant Kaiser Permanente in California went on strike.

The strike was organized by the National Union of Healthcare Workers. The union says Kaiser Permanente patients have been the victims of "chronic failure to provide its members with timely, quality mental health care."

On Thursday, about 150 Kaiser Permanente employees picketed the Woodland Hills Medical Center in the San Fernando Valley. One of them was therapist Deborah Silverman. In her eyes, the biggest problem at Kaiser right now is understaffing.

Silverman says there are so many patients waiting to see therapists, that Kaiser sends new patients to see her, even if she's already overbooked. She says for three days over a two-week period she had four people she didn't know.

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"I have to put them some place, and I didn't have any appointments for at least three weeks. So that's a huge emotional cost to me," Silverman says. "I either have to try to find someone else who has an open slot, which means the person has to switch, or people have to wait, and they've come to see you. It makes you feel — it really bumps up against our ethical standards."

Silverman says switching therapists often makes it difficult to establish a bond and make progress.

John Nelson, Kaiser Permanent's vice president of government relations, says the company delivers some of the highest-quality mental health care in California and in the country. But, he says, they absolutely want to get better.

"Really the only way we can do that is by working together," Nelson says. "So we need our therapists and psychologists and others to be working with us, and constructively on how to get better, and not walking away from patients and being gone for seven days."

But it's not just the union saying there's a problem at Kaiser.

In 2013, the state of California fined Kaiser $4 million, finding that some of these problems — like the long wait times, and the company discouraging people from seeking costly individual therapy — violated federal and state laws about mental health care.

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April Dembosky has been following the story for NPR member station KQED. She says even though Kaiser paid the fine last September, the union is still unhappy.

"They're arguing that Kaiser has simply shifted resources," Dembosky tells NPR's Arun Rath. "So that fine was directed mainly at initial visits ... [those] arguing they had to wait an unreasonably long time" to be seen for their first visit.

Dembosky says the union is alleging that now patients might get that initial appointment faster, but "good luck with a follow-up appointment."

"They're saying people are still being made to wait two, four, six weeks," she says.

Dembosky says she thinks what might be happening now, as far as patient wait times, is a result of campaigns that have sought to reduce stigma around mental health services. Some of that seems to have worked and more people with mental health problems are coming forward, she says.

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"In my reporting I'm seeing this come up in several other venues, not just at Kaiser," she says, including the state's university system. "This is something that ... is an issue that's coming up in other health care systems."

Dembosky says there is also a shortage of mental health care professionals to meet the demand of new patients — not enough people are completing the lengthy licensing process necessary to provide care.

Meanwhile, there's no sign that an agreement between Kaiser Permanente and the union is imminent — but Kaiser's mental health workers will be back on the job Monday.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

One Scientist's Race To Help Microbes Help You

NPR Health Blog - Sun, 01/18/2015 - 5:46am
One Scientist's Race To Help Microbes Help You January 18, 2015 5:46 AM ET Katherine Harmon Courage

Biologist Rob Knight, co-founder of the American Gut Project, recently moved the project to the University of California, San Diego's School of Medicine.

Casey A. Cass/University of Colorado

The rate of recent discoveries about the human microbiome has been dizzying. And Rob Knight wants to crank up the pace.

One of the top scientists in a field that's discovering possible bacterial influences on everything from diabetes to depression, Knight was also co-founder of a massive citizen science experiment called the American Gut Project. He recently moved from the University of Colorado, Boulder and took the gut project with him — to the medical school at the University of California, San Diego.

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The project lets anybody, for a $99 fee, have the microbes of the gut, mouth, skin or other orifices inventoried. And it's not just for people, but pets, too. Last year I roped my husband, mom and dog into having their gut microbes analyzed along with mine in hopes of discovering what microscopic stories we share. (You can read more about the results here.)

I caught up with Knight by phone on Friday to talk about what's next. Below is an edited version of our chat.

What is the current state of microbiome research?

Right now a lot of microbiome research is about pattern discovery. We're finding connections between microbes and all kinds of conditions we never knew they were involved with — ranging from obesity to colon cancer to rheumatoid arthritis and (in mouse models) even things like autism, depression and multiple sclerosis.

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In the future it's going to move beyond the correlations to actually finding out which of those conditions microbes cause — and which of those conditions we can either predict or modify with improved knowledge about the microbial world.

What are some of the current challenges in microbiome research?

In microbiome studies, some of the effects are so obvious that you can see them with just a handful of people. But other effects you might need to get a population of fives of thousands or tens of thousands to be able to understand what's going on.

That becomes especially true if you start to look at combinations of variables. So, maybe exercise has a particular effect on your microbiome if you're on a special diet, or if you're taking a particular drug. Once you start to look at those combinations of factors (talking about, say, racial or ethnic background, or medication or lifestyle effects, such as diet and exercise) in combination and trying to make predictions, you could see how you would need relatively large numbers of people to even begin to get anywhere.

Another challenge is in computation. The ability to generate the data has greatly outstripped a lot of people's ability to analyze the data.

Then there's the user interface. Especially if we want to get this into the hands of clinicians, which we do, and to people who want to interpret their own microbiome results, you really don't want a huge table of numbers. So we are trying to make this easy for users to understand — the same way that GPS went from being just inscrutable numbers to being a map where you can see, turn by turn, where you're supposed to go. That's what we mean to do for the microbiome — to make it easy to use.

With your move from CU Boulder to UCSD, where do you hope to take microbiome research next?

There are several things that are exciting about this move. One is that San Diego is one of the world's premier biotechnology hubs. So being able to collaborate with companies on technology and being able to help companies discover, for example, if a particular probiotic, prebiotic or diet will affect your microbiome. Being able to work with these companies directly to figure out whether their product has an effect — and whether that effect is beneficial or harmful — is really exciting.

Another factor is getting the resources at the [UCSD] medical school — and at the Rady Children's Hospital. The bio bank here is collecting 300,000 biological specimens a month, so we will be able to add a microbiome dimension to the study of diseases — including diseases where there is no hint yet that the microbiome is involved. When you consider the number of diseases where, just over the last five years, it went from being crazy to think the microbes were involved to now being crazy to think the microbes aren't involved, it's amazing how rapidly the evidence has been accumulating. There's a lot of potential there.

What's happening with the American Gut Project?

We have our equipment up and running in San Diego, so we're able to do DNA extractions, PCRs, sequencing and so forth. And samples that have been sent to Boulder are being redirected to San Diego, so no one needs to worry about their sample being lost!

What's next?

We're hoping to scale it up and decrease costs.

We want to reach out to people who share the same factors — whether it's people who live in the same area, do the same sport, have the same diet, are taking the same medication or have the same medical condition. Finding out what matters and what doesn't matter in your microbiome — and which of these factors in which you resemble another person also cause your microbiome to be similar — is going to be really fascinating.

I can't say anything too explicit yet, but we're also looking to partner with companies where we might be able to do things like integrated human genome and microbiome sampling.

We already launched the British Gut Project and the Australian Gut Project, and expanding those kinds of spinoffs to more countries is going to be exciting.

It's going to take a while, but the potential is just tremendous, especially given the disparities between countries — even those that share a border — in a lot of conditions that we now know are linked to the microbiome. So understanding what factors affect those health issues across different geographic regions is going to be very exciting.

We are also hoping to create an open platform where any scientist, physician, educator, student or anyone at a company can very rapidly look at the dataset to get an idea about what the effect on the microbiome a treatment or product might have — and then use that as a basis for designing more carefully controlled studies.

And we think there's a tremendous amount of potential for medical education about probiotics, prebiotics, antibiotics and the microbiome.

I think the possibility of not just discovering patterns but turning those patterns into things that actually affect and benefit people's lives is tremendous.

Katherine Harmon Courage is a freelance health and science journalist based in Colorado. She is the author of Octopus! The Most Mysterious Creature In the Sea, now available in paperback.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Teens Who Skimp On Sleep Now Have More Drinking Problems Later

NPR Health Blog - Fri, 01/16/2015 - 4:12pm
Teens Who Skimp On Sleep Now Have More Drinking Problems Later January 16, 2015 4:12 PM ET

Sleep-deprived teenagers find it difficult to focus in class, and they're more likely get sick. They are also more likely to develop problems with alcohol later on, according to a study published Friday in the journal Alcoholism: Clinical & Experimental Research.

The study included teens who suffered from conditions like insomnia as well as those who simply weren't getting enough sleep. Teenagers ages 14 through 16 who had trouble falling or staying asleep were 47 percent more likely to binge drink than their well-rested peers.

Sleep problems were linked to even more issues with alcohol later on.

Teens who had trouble sleeping when the researchers first checked in with them were 14 percent more likely to drive drunk and 11 percent more likely to have interpersonal issues related to alcohol a year later. And five years after that — when everyone was college-aged or older — those who had sleep issues in high school were 10 percent more likely to drive drunk.

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About 45 percent of adolescents don't get the recommended eight to 10 hours a night, polls show.

The findings are based on data collected from 6,500 adolescents who were part of the larger National Longitudinal Study of Adolescent Health, which began tracking a group of adolescents in the mid-90s.

Researchers have known for a while that lack of sleep and alcohol use are related, says Maria Wong, a psychologist at Idaho State University who led the study. "This study shows that sleep issues can actually precede and even predict alcohol use later on."

And the influence of sleep on drinking behaviors can be dramatic, Wong tells Shots. In the study, each extra hour of sleep the teens got corresponded with a 10 percent decrease in binge drinking.

"We're not saying that sleep is the only risk factor for alcohol use," Wong says. In fact, another study published in the same journal issue found that a combination of genetics and peer influence affect teens' decisions to drink.

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But a child's genetic makeup isn't something anyone can change, Wong says, "and beyond a certain extent, we cannot control whom kids spend time with outside the home."

Sleep, however, may be something that teenagers and their parents can control. "If we can make sure they have enough sleep, we can help them make good choices," Wong says.

Of course, that's much easier said than done. Teens don't usually take well to having bedtimes imposed on them. And even if they did, forcing kids to get in bed early won't necessarily help, says Dr. Maida Chen, the director of the Pediatric Sleep Disorders Center at Seattle Children's Hospital. "Because of their biology, simply saying to teens, 'Go to sleep earlier' is not a plausible solution," says Chen, who wasn't involved in the recent research.

The body's natural circadian rhythms tend to shift during adolescence, Chen explains, so teens may find it difficult fall asleep until 11 p.m. or midnight.

That's why many parents and pediatricians have been pushing to delay school start times for middle and high school students. "Teens have to get up at 5 or 6 in the morning in order to get to school by 7 or 8," Chen says, which means that most of them aren't getting nearly enough rest.

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Last year the American Academy of Pediatrics issued a policy statement calling on middle and high school to start at 8:30 a.m. or later.

"This new research shows what we have long suspected — there seems to be a link between lack of sleep and risky behaviors in teenagers," Chen says.

The people involved in the recent study were teenagers in the 1990s, Chen points out. "I wouldn't be surprised if the situation was in some ways worse these days," she says, "because nowadays, everyone has some electronic distraction that they carry into bed with them."

Many of the patients Chen sees at Seattle's Children come in because their grades have started to fall or because they're having behavior issues at school, she says.

"This is not just about teens not sleeping enough and then feeling a bit grumpy the next day," Chen says. "Sleep really affects their ability to function and make good decisions."

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

A Weight-Loss Device Aims To Curb Hunger By Zapping A Nerve

NPR Health Blog - Fri, 01/16/2015 - 11:56am
A Weight-Loss Device Aims To Curb Hunger By Zapping A Nerve January 16, 201511:56 AM ET Alison Bruzek

Electrical impulses generated by a pacemaker-like device are transmitted to the vagus nerve by electrodes.

Enteromedics

What if you could zap your hunger away? A device approved by the U.S. Food and Drug Administration on Wednesday promises to do just that.

The VBLOC vagal blocking device, developed by EnteroMedics of St. Paul, Minn., generates an electrical pulse in the vagus nerve, perhaps blocking communication between the brain and stomach. Normally, the nerve helps tell the brain whether the stomach is empty or full, among many other tasks.

"I suspect it blinds the brain of what's going on in the gastrointestinal tract," says Dr. Scott Shikora, director of the Center for Metabolic and Bariatric Surgery at Brigham and Women's Hospital and consulting chief medical officer to EnteroMedics. However, researchers don't really know why stimulating the vagus nerve might make people feel less hungry.

"A lot of the interest in the vagus nerve as an avenue to promote weight loss stems from animal studies that found that stimulating the vagus nerve close to the stomach resulted in weight loss and decreased eating," psychologist Jamie Bodenlos at Hobart and William Smith Colleges, who is unaffiliated with the device, told Shots via email.

Zapping the vagus nerve is not a new therapy. Vagus nerve stimulation has been approved by the FDA to treat chronic or recurrent depression that doesn't respond to treatment, as well as epilepsy. It also can be used for patients with gasteroparesis, a condition when the stomach doesn't empty completely.

The device is intended to interrupt signals sent from the stomach to the brain.

EnteroMedics

But VNS is not considered a first-line solution for those disorders, and it won't be for obesity, either.

This device won't be for most people who need to lose weight. It's only approved for patients over 18 who have unsuccessfully tried a weight loss program, have a body mass index of 35 to 45 and have an additional obesity-related illness like Type 2 diabetes.

The system includes three implanted devices. There's a pulse generator that sends electrical impulses, placed in the upper left chest, and two lead wires that are placed on the vagus nerve in the abdomen. Outside the body, the signals can be modified by a controller that attaches to a battery charger and a transmitter coil.

In a clinical trial, published in the September 2014 issue of JAMA, the journal of the American Medical Association, 233 patients in Australia and the United States with a BMI of 35 or greater used the device for 18 months. Some had it turned on, while others had the device implanted but inactive.

The participants had an average BMI of 41, which means a person who is 5 foot 8 would weigh 270 pounds. They were considered about 97 pounds overweight on average.

After 12 months, the group using an active device had lost about 24 percent of that excess weight, or 9 percent of their total body weight. That's compared to the people with the sham devices, who lost 16 percent of excess weight, or about 6 percent of body weight. The people who had the sham devices probably lost weight because of the placebo effect, the researchers speculate, and also because all of the people in the study were participating in a diet and exercise program.

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The people using the active devices did say they were less hungry. About 4 percent of people reported serious adverse events, including surgical complications, pain at the electrode sites, heartburn, and abdominal pain.

Although the device didn't help people lose 10 percent more excess weight, than the control group, which was the study's target, the FDA Advisory Committee on Gastroenterology-Urology Devices found that the benefits were still significant enough to approve the device for patients meeting certain criteria.

Researchers not involved with the device caution that the results show only moderate weight loss and shouldn't be overstated.

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"It is possible that this will be a component of treatment of obesity, but it's too early to tell," says Dr. Dario Englot, a neurosurgeon at the University of California San Francisco who has studied vagus nerve stimulation for epilepsy. "It's also possible that the effects that have been seen are the result of coincidence and this is going to be a fad that falls by the wayside."

However, Englot says, "Because obesity is such a problem, I think it's a positive step to try new treatments as long as we know that they're safe, and we know now that this is relatively safe."

The FDA hadn't approved an obesity device since September 2007, when the Realize gastric band was approved for bariatric surgery.

The FDA has ordered EnteroMedics to follow at least 100 additional patients over the next five years to collect safety and effectiveness data on weight loss and side effects with the device.

According to the company, they're working on getting insurance coverage for the device. They say pricing will be comparable to other bariatric procedures, in the $10,000 to $30,000 range.

But, says Englot, the best tool against obesity "continues to be a diet and exercise regime – and no surgical procedure or device is going to replace that."

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

By Making A Game Out Of Rejection, A Man Conquers Fear

NPR Health Blog - Fri, 01/16/2015 - 3:23am
By Making A Game Out Of Rejection, A Man Conquers Fear January 16, 2015 3:23 AM ET Listen to the Story 6 min 56 sec   Daniel Horowitz for NPR

Fear is one of the strongest and most basic of human emotions, and it's the focus of Fearless, the second episode of Invisibilia, NPR's new show on the invisible forces that shape human behavior.

This segment of the show explores how a man decided to conquer his fear of rejection by getting rejected every day — on purpose.

The evolution of Jason Comely, a freelance IT guy from Cambridge, Ontario, began one sad night several years ago.

"That Friday evening that I was in my one-bedroom apartment trying to be busy," Comely says. "But really, I knew that I was avoiding things."

See, nine months earlier, Jason's wife had left him.

"She ... found someone that was taller than I was — had more money than I had. ... So, yeah."

And since then, Jason had really withdrawn from life. He didn't go out, and he avoided talking to people, especially women.

But that Friday, he realized that this approach was taking a toll.

“ "I asked myself, afraid of what? I thought, I'm afraid of rejection."

"I had nowhere to go, and no one to hang out with," Comely says. "And so I just broke down and started crying." He realized that he was afraid. "I asked myself, afraid of what?

"I thought, I'm afraid of rejection."

Which got him thinking about the Spetsnaz, an elite Russian military unit with a really intense training regime.

"You know, I heard of one situation where they were, like, locked in a room, a windowless room, with a very angry dog, and they'd only be armed with a spade, and only one person is going to get out — the dog or the Spetsnaz."

And that gave him an idea. Maybe he could somehow use the rigorous approach of the Spetsnaz against his fear.

So if you're a freelance IT guy, living in a one-bedroom apartment in Cambridge, Ontario, what is the modern equivalent of being trapped in a windowless room with a rabid dog and nothing to protect you but a single handheld spade?

"I had to get rejected at least once every single day by someone."

He started in the parking lot of his local grocery store. Went up to a total stranger and asked for a ride across town.

"And he looked at me, like, and just said, 'I'm not going that way, buddy.' And I was like, 'Thank you!'

"It was like, 'Got it! I got my rejection.' "

Jason had totally inverted the rules of life. He took rejection and made it something he wanted — so he would feel good when he got it.

Cards from the Rejection Therapy game.

Courtesy of Jason Comely

"And it was sort of like walking on my hands or living on my hands or living underwater or something. It was just a different reality. The rules of life had changed."

Without knowing it, Jason had used a standard tool of psychotherapy called exposure therapy. You force yourself to be exposed to exactly the thing you fear, and eventually you recognize that the thing you fear isn't hurting you. You become desensitized. It's used in treating phobias like fear of flying.

Jason kept on seeking out rejection. And as he did, he found that people were actually more receptive to him, and he was more receptive to people, too. "I was able to approach people, because what are you gonna do, reject me? Great!"

That was when Jason got another idea.

He wrote down all of his real-life rejection attempts, things like, "Ask for a ride from stranger, even if you don't need one." "Before purchasing something, ask for a discount." "Ask a stranger for a breath mint."

He had them printed on a deck of cards and started selling them online.

Slowly, the Rejection Therapy game became kind of a small cult phenomenon, with people playing all over the world.

Cards from the Rejection Therapy game.

Courtesy of Jason Comely

Jason has heard from a teacher in Colorado, a massage therapist in Budapest, a computer programmer in Japan, even a widowed Russian grandmother. She's using rejection therapy to pick up men.

"That's really cool — so, there's an 80-year-old babushka playing Rejection Therapy," he says.

So what has Jason learned from all this?

That most fears aren't real in the way you think they are. They're just a story you tell yourself, and you can choose to stop repeating it. Choose to stop listening.

“ "Just get out there and get rejected, and sometimes it's going to get dirty. But that's OK, 'cause you're going to feel great after, you're going to feel like, 'Wow. I disobeyed fear.' "

"Don't even bother trying to be cool," Jason says. "Just get out there and get rejected, and sometimes it's going to get dirty. But that's OK, 'cause you're going to feel great after, you're going to feel like, 'Wow. I disobeyed fear.' "

To hear more about fear and what would happen if we made it disappear, listen to Fearless, the second episode of Invisibilia, NPR's newest program. It explores how invisible things shape our behavior and our lives. The program runs on many public radio stations, and the podcast is available for download at NPR.org and on iTunes.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Limited Insurance Choices Frustrate Patients In California

NPR Health Blog - Thu, 01/15/2015 - 5:20pm
Limited Insurance Choices Frustrate Patients In California January 15, 2015 5:20 PM ET

fromKXJZ

Pauline Bartolone Listen to the Story 3 min 30 sec  

Dennie and Kathy Wright sift through a stack of medical bills at their home in Indian Valley, Calif.

Pauline Bartolone for NPR

Dennie Wright lives in Indian Valley, a tiny alpine community at the northern end of the Sierra, close to the border with Nevada.

Wright works as a meat cutter in a grocery store and lives in a modest home overlooking a green pasture. He also lives in one of the 250 ZIP codes where Blue Shield of California stopped selling individual policies in 2014. As his insurance agent explained it, Wright had only one choice of companies if he wanted to buy insurance on Covered California, the state's health insurance exchange. That lone option was Anthem Blue Cross, so Wright bought one of the Anthem policies.

"That was new to us, you know, Covered California," Wright says. "Anthem Blue Cross was the insurance carrier. Then of course, three months later, I have a heart attack."

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More than once, he was flown across the state line to Reno for care. Wright and his wife, Kathy, now have piles of medical bills and insurance paperwork. Though Anthem Blue Cross covers emergency care out of state, it doesn't cover routine doctor care outside a patient's home state. But Wright says traveling from his home to doctors on the California side of the mountains is not as safe or as convenient as going to Reno.

He continues to see the Nevada doctors who put a defibrillator in his chest and saved his life. Anthem Blue Cross will pay some of the bills, but the Wrights still don't know if everything will be covered.

There are other insurance options for Wright, but not through Covered California. Although he didn't need a subsidy, he was left in the same position as people in his area who do need financial help to buy insurance. People with lower incomes can't readily take their business to a competitor, because the state exchange is the only place customers can use federal subsidies to help them buy health insurance. So for these people who are pinched financially, Anthem is the only option.

"I mean, you should have some choices, especially if you're going to have one that's not going to cover you in the places you choose to go," Wright says.

Last July, Covered California Executive Director Peter Lee offered a different impression of choices the marketplace would offer.

"In every corner of the state, consumers will have at least two plans to choose from, and in most areas, where most of the Californians live, they can choose between five or six plans," said Lee during an event to announce the marketplace's 2015 plans and premium rates.

Northern California Pricing Region

Almost half of the Covered California members who have one choice of insurer live in Northern California.

Source: Covered California

Credit: Alyson Hurt/NPR

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But in 22 counties in Northern California, there are ZIP codes where there is only one choice of insurer, even if that company offers a few different plans. There are areas around Monterey and Santa Cruz on California's central coast that also have only one carrier.

Blue Shield of California said it had to stop selling individual plans in areas that didn't have a hospital contracted with Blue Shield. The insurance firm said it had offered doctors in those areas rates of payment that would keep premiums low, but not all doctors accepted the payment terms.

Covered California estimates that statewide, there are 28,896 Covered California customers who have only one choice of insurance carrier — slightly over 2 percent of the total exchange membership as of November 2014.

Lee says the exchange is now working to increase the range of choices in places where there are none. But he says the problem predated the exchange.

"The challenges of northern, rural counties have been there for a long time," Lee says, "and are still a challenge that we're trying to address head-on."

He says the exchange is now discussing with others how to bring more insurer competition to these areas in 2016.

"We aren't the solution to all the problems that have always been there in terms of challenges in rural communities, and that's something we're certainly looking at — how to improve access and choice," Lee says. "And we'll continue doing that."

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Covered California should help increase the number of insurers, says consumer advocate Anthony Wright from Health Access. And policymakers, he says, should lean on insurers and providers to participate in that market.

"Some of this is a combination of putting pressure on the insurers," he says, "and some of this is trying to do work to actually increase the number of providers on the ground in these areas — whether through more training, [or] incentives to be in some of these more rural areas."

Having more insurers in the marketplace, says Anthony Wright, would make it more likely that people can get the care they need.

"At one level, we're trying to make a functioning market," he says, "but it still means that consumers are at the mercy of the market."

This year, people who want more choice than Covered California offers, must venture into the broader health insurance market — if they can afford it.

This story is part of an NPR reporting partnership with Capital Public Radio and Kaiser Health News.

Copyright 2015 Capital Public Radio. To see more, visit http://www.capradio.org.
Categories: NPR Blogs

This Year's Flu Vaccine Is Pretty Wimpy, But Can Still Help

NPR Health Blog - Thu, 01/15/2015 - 1:42pm
This Year's Flu Vaccine Is Pretty Wimpy, But Can Still Help January 15, 2015 1:42 PM ET Listen to the Story 3 min 13 sec  

Bruno Mbango Enyaka gets his flu shot at a community health center in Portland, Maine, on Jan. 7.

Gabe Souza/Press Herald via Getty Images

As expected, this year's flu vaccine looks like it's pretty much of a dud.

The vaccine only appears to cut the chances that someone will end up sick with the flu by 23 percent, according to the first estimate of the vaccine's effectiveness by the federal Centers for Disease Control and Prevention.

The CDC had predicted this year's vaccine wouldn't work very well because the main strain of the flu virus that's circulating this year, known as an H3N2 virus, mutated slightly after the vaccine was created. That enables the virus to evade the immune system response created by getting vaccinated.

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The effectiveness of the flu vaccine varies dramatically from year to year, but can be as high as 50 percent to 60 percent, the CDC says. So if the early estimate of this year's vaccine's effectiveness, reported in this week's Morbidity and Mortality Weekly Report, holds up, it would put the protection at the low end.

Nevertheless, the CDC and others are still urging people to get their flu shots because the vaccine does appear to work well against other, less common strains of the virus that are circulating, and they could become more common as the flu season progresses. We're about halfway through.

"The flu season is not yet over," said William Schaffner, an infectious disease expert at Vanderbilt University. "There are other less impressive strains that are out there making people sick, and against those strains the vaccine is actually on target. So it's providing partial protection."

The CDC has been predicting that this year could be a bad year for the flu because of the expectation that the vaccine wouldn't work very well and because H3N2 viruses tend to be pretty nasty. So the CDC has been urging doctors to be more aggressive about using antiviral drugs like Tamiflu and Relenza when their patients get the flu, especially those at high risk for complications.

"Physicians should be aware that all hospitalized patients and all outpatients at high risk for serious complications should be treated as soon as possible with one of three available influenza antiviral medications if influenza is suspected, regardless of a patient's vaccination status and without waiting for confirmatory testing," the CDC's Joe Bresee said in a statement.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Why I Left The ER To Run Baltimore's Health Department

NPR Health Blog - Thu, 01/15/2015 - 1:22pm
Why I Left The ER To Run Baltimore's Health Department January 15, 2015 1:22 PM ET Leana Wen

Dr. Leana Wen became Baltimore's health commissioner on Thursday.

Mark Dennis/City of Baltimore

When I was just beginning my third year as a medical student, I learned an important lesson about what matters most in health.

It was a typical summer afternoon in St. Louis, with the temperature and humidity both approaching 100. My patient was a woman in her 40s who was being admitted to the hospital because her lungs were filling with fluid, a complication of kidney failure. She had missed all three dialysis appointments that week.

She told me that her son had been arrested, and he was the one who drove her back and forth from the dialysis clinic. She couldn't pay her bills, and her electricity had been shut off.

When I relayed her story to my supervisor, the attending physician, he cut me off. "It's not your job to open Pandora's box," he said. "Don't ask questions you don't want to know the answers to."

I was dismayed. I grew up in poor neighborhoods around Los Angeles where families routinely had to choose between transportation and food, between medicines and shelter. My patient could have been my mother or my aunt.

I felt compelled to ask my patient about her life so that I could understand the social factors that play such a key role in health. But after that reprimand and many more experiences like it, I learned that this wasn't what most doctors do.

Shots - Health News Heart Of The Matter: Treating The Disease Instead Of The Person

So I began to inhabit two worlds. In one world, I became an ER doctor who diagnoses diseases and treats health problems fast. I help children having asthma attacks breathe. I treat the victims of gun violence by putting tubes in their chests and stabilizing them for surgery. And I resuscitate patients having heart attacks. My job puts me at the front line of public health crises, but it is the dedicated nurses, social workers, and case managers who devise ways to connect our patients with the resources they need in the community.

In my other world, I became an activist and public health professor. I worked on national and international policies that would encourage more equitable access to health care and life-saving pharmaceuticals. While taking my case to officials in Washington, D.C., and Geneva, I learned how important people's immediate environment is to their health. Removing lead from homes and eliminating indoor pollutants help children stay healthy and able to learn. Designing streets for walking and ensuring affordable, nutritious food help prevent obesity and reduce the future costs of diabetes and heart disease.

Shots - Health News When Patients Read What Their Doctors Write

Policy decisions that affect everyday life are the ones that can do the most for people's health. For all the billions of dollars invested in new technologies, it's still our environment — indeed, our zip codes — that predicts more about our health than our genetic codes. Where people live, work and play is where we can do the most to prevent disease and ensure wellness.

Now, I have the opportunity to bridge the worlds of frontline medical care and public policy. On Thursday, I began serving as the Health Commissioner of Baltimore City and will lead the oldest, continuously-operating health department in the U.S.

Like many other cities, Baltimore has problems rooted in poverty that have persisted for generations. But the city also has scores of amazing, committed leaders, starting with Mayor Stephanie Rawlings-Blake, who has demonstrated her willingness to tackle big problems with bold solutions. When she talked with me about joining her administration, I saw how well she understands the critical importance of health to other social policies. We also share a common vision that includes helping our children achieve their highest potential, curbing the epidemic of substance abuse and achieving health care access and equity.

The move from academia and daily medical practice to city government presents a daunting challenge, but it's one that I have spent my entire life preparing to face. Given where I come from and what I've seen, I just can't accept geography or circumstance as destiny.

I love clinical practice, and I will miss it. I'll also miss teaching the terrific students and residents I've had the privilege of learning from as well.

But I feel ready to tear Pandora's box wide open and take on the hard problems. I want to ask what I couldn't in medical training. I want to go beyond figuring out how to get one patient to dialysis and instead tackle the factors that led her and many people like her to develop kidney failure in the first place.

I am eager to bring together hospitals, civic leaders, government, frontline providers and people in the community to work on what matters most to improve health for all.

Dr. Wen is an emergency physician and the Health Commissioner of Baltimore City. She is the author of "When Doctors Don't Listen: How to Avoid Misdiagnoses and Unnecessary Care," and founder of Who's My Doctor, a project to encourage transparency in medicine.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Health Insurance Prices: Highest In Alaska, Lowest In Sun Belt

NPR Health Blog - Thu, 01/15/2015 - 9:09am
Health Insurance Prices: Highest In Alaska, Lowest In Sun Belt January 15, 2015 9:09 AM ET

Partner content from

Jordan Rau

Alaska: home to Denali National Park and Preserve, grizzly bears and some very pricey health insurance.

Universal Images Group/UIG via Getty Images

In health insurance prices, as in the weather, Alaska and the Sun Belt are extremes. This year Alaska is the most expensive health insurance market for people who do not get coverage through their employers, while Phoenix, Albuquerque, N.M., and Tucson, Ariz., are among the very cheapest.

The best insurance deals by region and county


$166 Phoenix, Ariz. (Maricopa)
$167 Albuquerque, N.M. (Bernalillo, Sandoval, Torrance and Valencia count)
$167 Louisville, Ky. (Bullitt, Jefferson, Oldham and Shelby)
$170 Tucson, Ariz. (Pima and Santa Cruz)
$170 Pittsburgh, Pa. (Allegheny and Erie)
$179 Western Pennsylvania (Beaver, Butler, Washington, Westmoreland, Armstrong, Crawford, Fayette, Greene, Indiana, Lawrence, McKean, Mercer, and Warren)
$181 Knoxville and Eastern Tennessee (Anderson, Blount, Campbell, Claiborne, Cocke, Grainger, Hamblen, Jefferson, Knox, Loudon, Monroe, Morgan, Roane, Scott, Sevier, and Union)
$181 Minneapolis-St. Paul (Anoka, Benton, Carver, Dakota, Hennepin, Ramsey, Scott, Sherburne, Stearns, Washington, and Wright)
$184 Memphis and suburbs (Fayette, Haywood, Lauderdale, Shelby, and Tipton)
$189 North of Minneapolis (Chisago and Isanti)

(Premiums are for the lowest-cost silver plan for 40-year-olds, but in most cases, the areas with the highest and lowest premiums stay the same no matter the age.)

In this second year of the insurance marketplaces created by the federal health law, the most expensive premiums are in rural spots around the nation: Wyoming, rural Nevada, patches of inland California and the southernmost county in Mississippi, according to an analysis by the Kaiser Family Foundation, which has compiled premium prices from around the country. (KHN is an independent program of the foundation.)

The most and least expensive regions are determined by the monthly premium for the least expensive "silver" level plan, which is the type most consumers buy and covers on average 70 percent of medical expenses. Premiums in the priciest areas are triple those in the least expensive areas. The national median premium for a 40-year-old is $269, according to the foundation.

Along with the three southwestern cities, the places with the lowest premiums include Louisville, Ky., Pittsburgh and western Pennsylvania, Knoxville and Memphis, Tenn., and Minneapolis-St. Paul and many of its suburbs, the analysis found.

Starting this month, the cheapest silver plan for a 40-year-old in Alaska costs $488 a month. (Not everyone will have to pay that much because the health law subsidizes premiums for low-and moderate-income people.) A 40-year-old Phoenix resident could pay as little as $166 for the same level plan.

That three-fold spread is similar to the gap between last year's most expensive area — in the Colorado mountain resort region, where 40-year-olds paid $483—and the least expensive, the Minneapolis-St. Paul metro area, where they paid $154.

Minneapolis remained one of the cheapest areas in the region, although the lowest silver premium rose to $181 after the insurer that offered the cheapest plan last year pulled out of the market. Premiums in four Colorado counties around Aspen and Vail plummeted this year after state insurance regulators lumped them in with other counties in order to bring rates down.

The areas and counties with the highest premiums

$488 Alaska (entire state)
$459 Ithaca, NY (Tompkins)
$456 Bay St. Louis, Mississippi (Hancock)
$446 Plattsburgh, NY (Clinton)
$440 Rural Wyoming (Albany, Big Horn, Campbell, Carbon, Converse, Crook, Fremont, Goshen, Hot Springs, Johnson, Lincoln, Niobrara, Park, Platte, Sheridan, Sublette, Sweetwater, Teton, Uinta, Washakie, and Weston)
$428 Vermont (entire state)
$418 Rural Nevada (Churchill, Elko, Eureka, Humboldt, Lander, Mineral, Pershing, and White Pine)
$412 Casper, Wyoming (Natrona)
$410 Inland California (Imperial, Inyo, and Mono)
$401 Cheyenne, Wyoming (Laramie)

(Premiums are for the lowest-cost silver plan for 40-year-olds, but in most cases, the areas with the highest and lowest premiums stay the same no matter the age.)

Alaska's lowest silver premium rose 28 percent from last year, ratcheting it up from 10th place last year to the nation's highest. Only two insurers are offering plans in the state, the same number as last year, but the limited competition is just one reason Alaska's prices are so high, researchers said. The state has a very high cost of living, which drives up rents and salaries of medical professionals, and insurers said patients racked up high costs last year.

Ceci Connolly, director of PwC's Health Research Institute, noted that the long distances between providers and patients also added to the costs. Restraining costs in rural areas, she said, "continues to be a challenge" around the country. One reason is that there tend to be fewer doctors and hospitals, so those that are there have more power to dictate higher prices, since insurers have nowhere else to turn.

By contrast, in Maricopa County, Phoenix's home, the lowest silver premium price dropped 15 percent from last year, when Phoenix didn't rank among the lowest areas. A dozen insurers are offering silver plans. "Phoenix, during the boom, attracted a lot of providers so it's a very robust, competitive market," said Allen Gjersvig, an executive at the Arizona Alliance for Community Health Centers, which is helping people enroll in the marketplaces.

The cheapest silver plan in Phoenix comes from Meritus, a nonprofit insurance cooperative. The plan is an HMO that provides care through Maricopa Integrated Health System, a safety net system that is experienced in managing care for Medicaid patients. Meritus' chief executive, Tom Zumtobel, said they brought that plan's premium down from 2014. The insurer and the health system meet regularly to figure out how to treat complicated cases in the most efficient manner. "We're working together to get the best outcome," Zumtobel said.

Katherine Hempstead, who oversees the Robert Wood Johnson Foundation's research on health insurance prices, found no significant differences in the designs of the plans that would explain their premiums. "In most of the plans – cheap or expensive – there seemed to be a high deductible and fairly similar cost-sharing," she said.

Copyright 2015 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.
Categories: NPR Blogs

From The Mouths Of Apes, Babble Hints At Origins of Human Speech

NPR Health Blog - Wed, 01/14/2015 - 4:33pm
From The Mouths Of Apes, Babble Hints At Origins of Human Speech January 14, 2015 4:33 PM ET Listen to the Story 3 min 53 sec  

Tilda the orangutan, relaxing between gabfests at the Cologne Zoo.

Cologne Zoo

An orangutan named Tilda is providing scientists with fresh evidence that even early human ancestors had the ability to make speechlike vocalizations.

Tilda has learned to produce vocalizations with striking similarities to human speech, scientists report in the journal PLOS ONE. If you listen without knowing the source, "you might wonder whether or not it is a human," says Rob Shumaker, an author of the paper and vice president of the Indianapolis Zoo.

The finding could help answer a big question about our human ancestors' ability to produce speech before they developed a modern vocal tract and brain. If orangutans and other great apes can make speechlike sounds, it stands to reason that early humans could too, Shumaker says.

Tilda, who is about 50 now, was born in the wilds of Borneo, where orangutans make calls that often include sounds like kisses, squeaks and grunts. But she was captured young and has spent most of her life around people.

Eventually, Tilda learned to imitate people, says Adriano Lameira, the lead author of the paper and a founder of the Pongo Foundation, which studies orangutans and works to protect them.

Tilda waves her arms and shakes her head the way people do, Lameira says. She also reportedly smoked cigarettes before she got to the zoo (maybe by way of her prior life as an "entertainment animal," the scientists say). And Tilda whistles, something orangutans don't do in the wild.

It was the whistling that led researchers to discover Tilda's vocal skills. Lameira was part of a team studying orangutans that can whistle. But when they visited Tilda and began recording her behavior on video, she did something different.

"We were waiting for the whistles and suddenly she started to do these bizarre calls," Lameira says. It was unlike anything he'd ever heard from an orangutan, in the wild or in captivity. He says the rhythmic strings of consonants and vowels were like a cartoon approximation of a person speaking.

"She was producing these calls repeatedly and really quick," he says. "And this is also what we observe in humans while we are speaking to each other. We are, on average, producing five consonants and five vowels per second."

Additional Information:

The rhythmic strings of consonants and vowels that Tilda emits, and the pattern variation, match the frequency and style of human speech production — something scientists didn't think apes could do.

Credit: PLOS ONE

An analysis of Tilda's "faux speech" later showed she was matching that frequency precisely. "This was really what astonished us," Lameira says.

Science The Chimp That Learned Sign Language The Human Edge Signing, Singing, Speaking: How Language Evolved

The finding goes against earlier thinking that great ape vocalizations are reflexive and very limited, Shumaker says. "What we have to do is discard this old idea that apes are simply incapable of doing anything remotely similar to human speech production," he says. "I think what we're finding is there's a lot more flexibility than we realized."

The research on orangutan whistling showed that great apes could learn to make new sounds, Shumaker says. And the study of Tilda suggests they also can learn new vocal patterns. Taken together, he says, the research hints that great apes could be a model for the development of speech in early humans.

It will take more animals with Tilda's abilities to confirm the hypothesis, Shumaker says. But, he adds, "I think as we start looking, we'll find out Tilda is not the only orangutan like this."

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Early Test Of An Obamacare Experiment Posts Little Progress

NPR Health Blog - Wed, 01/14/2015 - 1:21pm
Early Test Of An Obamacare Experiment Posts Little Progress January 14, 2015 1:21 PM ET

Partner content from

Jay Hancock

Obama administration officials have warned that ambitious experiments run by the health law's $10 billion innovation lab wouldn't always be successful. Now there is evidence their caution was well placed.

Only a small minority of community groups getting federal reimbursement to reduce expensive hospital readmissions produced significant results compared with sites that weren't part of the $300 million program, according to partial, early results.

The closely watched program is one of many efforts to control costs and improve care being run by the Center for Medicare and Medicaid Innovation, which was created by the Affordable Care Act.

Dozens of community agencies on aging, from Ventura County, Calif., to southern Maine, were offered money to try to ensure that older people leaving the hospital received care that reduced their chances of being readmitted within a month.

Medicare Fines Record Number Of Hospitals For Excessive Readmissions

Preventable hospital readmissions are estimated to cost Medicare $17 billion a year.

But an early evaluation found that only four of the 48 groups studied in the Community-based Care Transition Program significantly cut readmissions compared with those in a control group.

At the same time, 29 groups have either withdrawn from the program or have been terminated by the Department of Health and Human Services for failing to achieve targets, agency officials said. The CCTP project, which has grown since this evaluation was done, now has 72 participating sites that administration officials hope will reduce readmissions and lessons in improving post-hospital care.

The evaluation, produced under contract with HHS by the consulting firm Econometrica, is one of the first independent analyses of an innovation-lab project to be made public. It is dated May 30, 2014, but was posted on HHS' website Jan. 2.

But analysis said it's too soon to pronounce substantial judgment on CCTP.

"It's really too early to tell," said Ellen Lukens, who leads the practice on hospital and post-hospital care at Avalere Health, a consulting firm. "Can you really evaluate this when it's been such a short period of time?"

Shots - Health News Medicare Pulls Back The Curtain On How Much It Pays Doctors

A five-year experiment, the program signed its first round of deals with community agencies in late 2011, and its fifth and last round in March 2013. Econometrica's report covered partial results from groups participating in the early rounds, including some for which only a few months of data were available. Congress required the lab to closely monitor all projects, which explains the early evaluation.

With less than one site in 10 significantly reducing readmissions, the result "seems kind of wimpy," said Eric Coleman, a professor at the University of Colorado whose previous work on care for discharged patients influenced the CCTP program. He said he remains optimistic about the project, however, also noting that the results are early. He also praised HHS for cutting off nonperforming groups.

"This is really the first glance of the first two waves of the program," said HHS spokesman Raymond Thorn. "It's too early to determine whether this model is failing or not. We will have successes."

CCTP is one of dozens of experiments being run by HHS' innovation lab, which has a 10-year, $10 billion budget.

Shots - Health News Hospitals Torn On Reducing Repeat Admissions

Paying community agencies to work with hospitals was thought to be one potential way of reducing readmissions. But rather than getting grants, the agencies are paid according to the number of cases they handle.

The program faces several challenges. In awarding funding, HHS favored groups working with hospitals with high readmission rates, perhaps making success more difficult.

Plus numerous groups and hospitals are working to cut readmissions through other means. That increases competition for aging agencies trying to make their mark, and makes it more difficult to measure the impact of each program.

Readmissions have been dropping nationally since Medicare began penalizing hospitals in late 2012 for having too many. Some CCTP groups did reduce readmissions — but so did hospitals that didn't get help. That means the system improved overall in those areas and money was saved, but statistically the aging agencies did not show up as the critical factor.

Coleman faulted HHS for requiring agencies to file detailed reports on care models and administration rather than letting them focus on the main job.

"If it doesn't reduce readmissions it's game over, so why do you want all these process measures?" he said. "If we want these sites to succeed, we need to get out of their way."

Originally more than 100 agencies agreed to participate. But 29, including New York Methodist Hospital and Pennsylvania's Delaware County Office of Services for the Aging, have withdrawn or didn't have contracts renewed because they missed readmission-reduction or enrollment targets, HHS said.

A complete list of agencies that have left the program is here.

The health-law innovation program also includes projects using accountable care organizations to cut costs and improve care quality; giving more resources to primary-care doctors to coordinate care; and awards to make Medicare more efficient.

Administration officials like to compare the lab to a venture capital fund, in which many investments are expected to fail but a few succeed spectacularly. Many Republicans think it's a waste.

Copyright 2015 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.
Categories: NPR Blogs

Working Longer Hours Can Mean Drinking More

NPR Health Blog - Wed, 01/14/2015 - 10:33am
Working Longer Hours Can Mean Drinking More January 14, 201510:33 AM ET

It's been a long day. Time to unwind.

iStockphoto

People who try to reduce the stress of a long work day with a drink or two, or three, may be causing more health problems for themselves.

Around the world, people working long hours are more likely to drink too much, according to a study that analyzed data from 61 studies involving 333,693 people in 14 countries.

They found that people who worked more than 48 hours a week were 13 percent more likely to engage in risky drinking than people working 35 to 40 hours a week.

Shots - Health News Cheap Drinks And Risk-Taking Fuel College Drinking Culture

And since almost 40 percent of Americans working full time work more than 50 hours a week, according to a 2014 Gallup poll, that could mean a lot of problem drinkers.

Since the researchers are based in Finland, they defined risky drinking by the European standard as more than 14 drinks per week for women and 21 drinks for men. In the U.S., risky drinking is defined more conservatively, at more than 7 drinks per week for women and more than 14 drinks per week for men.

No matter which numbers constitute too much alcohol, we do know that drinking alcohol increases risk for liver disease, cancer, stroke, coronary heart disease and mental disorders.

Shots - Health News Binge Drinking: Risky And Widespread

And while people may be imbibing to reduce the stress of working long hours, that habit may be increasing stress on the job due to increased sick leave, poor performance, impaired decision making and occupational injuries.

Depression and sleep problems may be contribute to the link between working too much and risky drinking, the study authors speculate. Or it could be that competitive jobs that demand long hours have a culture that encourages heavy drinking. Think The Wolf of Wall Street.

This study didn't find differences in long work hours and drinking among socioeconomic groups, or by sex. So there's no way to know if people are drinking more because they're struggling to make a living or living the high life.

The study was published Wednesday in The BMJ.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Health Insurance Startup Collapses In Iowa

NPR Health Blog - Wed, 01/14/2015 - 3:16am
Health Insurance Startup Collapses In Iowa January 14, 2015 3:16 AM ET

fromWOI

Clay Masters Listen to the Story 3 min 51 sec  

It was a heck of a Christmas for David Fairchild and his wife, Clara Peterson. They found out they were about to lose their new health insurance.

"Clara was listening to the news on Iowa Public Radio and that's how we found out," Fairchild says. They went to their health plan's website that night. "No information. We still haven't gotten a letter about it from them."

David Fairchild and Clara Peterson own a small cleaning business in Iowa. The couple had health insurance via CoOportunity Health before the co-op faltered.

Clay Masters/Iowa Public Radio

The two are the sole employees of a cleaning service and work nights. Fairchild has chronic leukemia but treats it with expensive medicine. Last year they saved hundreds of dollars switching from the insurer Wellmark to a plan run by CoOportunity Health. For the first time in a long time, Fairchild says, they felt like they had room to breathe.

"Basically it covered our office visits; covered exams," he says. "It covered all but $40 of the medicine every four weeks. It was just marvelous. It probably was too good to be true."

It was for them. CoOportunity Health has failed. The Affordable Care Act set aside funding for health care co-ops, to enable the organizations to compete in places where there aren't many insurers. CoOportunity Health was the second- largest co-op in the country in terms of membership, and one of the largest in terms of the federal funding it received.

But then CoOportunity hit a kind of perfect storm, says Peter Damiano, director of the University of Iowa's public policy center. First, the co-op had to pay a lot more medical bills than those in charge expected.

"CoOportunity Health's pool of people was larger than expected, was sicker than expected," Damiano says. "So their risk became much greater than the funds that were available."

The reason the co-op's customers were sicker has a lot to do with what the insurance market looked like in Iowa before Obamacare. The largest insurer by far in the state was and still is Wellmark. But Wellmark decided not to offer any plans on Iowa's health exchange, leaving just CoOportunity and one other insurer — Coventry — offering plans on the exchange throughout the state.

On top of that, when the Obama administration in late 2013 allowed people to keep the insurance plan they already had, many customers happy with Wellmark stayed put. Damiano says this meant many of the customers who flocked to CoOportunity tended to be like Fairchild — people with expensive health problems who'd had trouble paying for insurance before, in the market Wellmark dominated.

Iowa Insurance Commissioner Nick Gerhart urges clients of CoOportunity Health to move their coverage to another carrier as soon as possible.

Clay Masters/Iowa Public Radio

"It was always going to be a challenging market to try to reach," says Damiano, "and on top of that, the whole idea of co-ops was relatively new and experimental. But it was to try to create competition, on that private sector approach," says Damiano.

Not only were the patients sicker, but CoOportunity's leaders initially thought they would enroll about 12,000 people in Iowa and Nebraska. They got about 10 times that, according to Nick Gerhart, Iowa's insurance commissioner.

Also, Gerhart says, the co-op thought it was going to get more federal money.

"On Dec. 16 around 4 o'clock we were informed they weren't going to get any further funding," he says. "Nothing was pulled — it just wasn't extended further."

Gerhart is now essentially the CEO of the co-op because the state has taken it over. He likens the situation to a small business suddenly having its credit shut off by the bank. Even though CoOportunity is not officially dead yet, Gerhart is telling its customers to switch insurers.

He says it's too early to make predictions about the fate for all co-ops.

Shots - Health News Small Health Insurance Co-Ops Seeing Early Success Shots - Health News Hitches On Health Exchanges Hinder Launch Of Insurance Co-op

"Ours was the second-largest in the country, so you've got to look at it that way," Gerhart says. "If the second-largest can't make it, how viable are the other ones? I don't know. But at the end of the day they didn't have enough capital to support 120,000 members."

In a written statement, Dr. Martin Hickey, chairman of the board of the National Alliance of State Health Co-Ops, said, "The news about CoOportunity Health is not a statement on the health insurance co-op program or the co-op concept. It's a reflection on the fact that all insurers — not just co-ops — are operating in unique markets with unique business plans and varying state regulations. The circumstances for CoOportunity Health in Iowa are not the same as those in the 23 other states in which co-ops are currently operating."

But the co-op's failure in Iowa has left Fairchild and Peterson scratching their heads.

"I mean the whole Affordable Care Act is [about] competition between insurance companies, and now we're back down to what?" says Peterson.

For them, only one option: Coventry. They've already applied through HealthCare.gov and now they're now waiting for approval for a plan that will cover a lot less of Fairchild's medicine expenses.

This story is part of a partnership between NPR and Kaiser Health News.

Copyright 2015 Iowa Public Radio. To see more, visit http://www.iowapublicradio.org.
Categories: NPR Blogs

U.S. Funding of Health Research Stalls As Other Nations Rev Up

NPR Health Blog - Tue, 01/13/2015 - 1:00pm
U.S. Funding of Health Research Stalls As Other Nations Rev Up January 13, 2015 1:00 PM ET

Though the United States is still leading the world in research related to diseases, it is rapidly losing its edge, according to an analysis in the American Medical Association's flagship journal JAMA.

If you look at biomedical research around the globe, the United States funded 57 percent of that work a decade ago. The U.S. share has since dropped to 44 percent, according to the study published online Tuesday.

U.S. funding for medical research by source, 1994-2012. (Data were adjusted to 2012 dollars using the Biomedical Research and Development Price Index.)

American Medical Association

"At the same time support for biomedical research in the United States has wavered, global interest in biomedical research is increasing," wrote Dr. Hamilton Moses III, founder of Alerion Advisors, and his five co-authors on the paper.

China still lags far behind the United States in its medical research spending, but its effort has been growing at a blistering rate: 17 percent per year, between 2004 and 2011, compared with 1 percent per year for the United States. More Chinese citizens than Americans now work in fields of science and technology, the study says.

This 16-page "special communication," along with supporting documents published online, offers one-stop shopping for people who want statistics on the state of funding for medical research.

Although the economic analysis focuses on the dollars and cents, the authors note that medical research holds a much deeper meaning for many Americans.

Shots - Health News By The Numbers: Search NIH Grant Data By Institution Shots - Health News U.S. Science Suffering From Booms And Busts In Funding

"For any current or future patient, research provides hope," the scientists write. "For the researcher, unanswered biological and clinical questions are endlessly fascinating. For a company or its investors, new products and services promise financial return."

Biomedical research affects not only a nation's health, they say, but international competitiveness, too.

Shots readers may recall the stories we posted last fall about the effects of declining federal funding for biomedical research. That's just one piece of the story. The National Institutes of Health provides about $30 billion toward annual expenditures of $117 billion. That total includes funding from industry, foundations and other private sources.

And while $117 billion is a big number, it represents 0.7 percent of the nation's gross domestic product. At the same time, health care now makes up more than 17 percent of the nation's economy. The paper notes that there's comparatively little funding for research to make our health care system more efficient and less expensive.

Overall, industry has increased its spending on biomedical research, but that's not true for all endeavors. For example, pharmaceutical firms actually reduced their spending slightly between 2004 and 2012, the study says.

Growth in U.S. funding for medical research by source 1994-2012.

American Medical Association

Drug companies spent less on the sort of early-stage research that aims to identify potential drugs, and comparatively more on human tests of safety and efficacy of drugs that are further along in the pipeline. Even so, the number of new drugs approved by the Food and Drug Administration is hovering around just 26 per year.

Medical device manufacturers and biotech companies have been areas of much more robust growth, the researchers find. Together, these two sectors account for 27 percent of medically oriented research in this country. That's similar to the NIH's share.

Moses and his colleagues join a chorus of scientists voicing concern about the United States' teetering support for medical research. "Given global trends, the United States will relinquish its historical innovation lead in the next decade," the researchers warn, unless there's a fresh infusion of public and private money.

"The main reason to increase expenditures on biomedical research and health services research is to capitalize on the investment already made in the past — to put that knowledge to work at the bedside, in real patients," Moses tells Shots.

Given the current political situation, Moses says, that will take creative new financial approaches, such as new bonds tailored for biomedical research. "We believe that this can fundamentally be funded by the private sector," he says, adding, though, that the government will continue to play a critical role in funding research that's simply too speculative and risky for investors to bankroll.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Breaking Up Is Hard To Do, But Science Can Help

NPR Health Blog - Tue, 01/13/2015 - 11:59am
Breaking Up Is Hard To Do, But Science Can Help January 13, 201511:59 AM ET iStockphoto

My boyfriend and I were together for over three years, and then we weren't. The days after the breakup involved lots of crying, and an embarrassing amount of Taylor Swift.

A couple of weeks later, once I was able to will myself out of sweatpants, my friend Eric — who was also coping with a breakup — came over for some IPAs and, of course, Taylor Swift singalongs.

We commiserated about how much life sucked, how lonely we felt and how we were losing sleep. We discussed what was wrong in each of our relationships and what was right.

"I hope talking about this so much isn't bringing you down," I told Eric.

"No, this actually really helps," he said.

It turns out we were on to something. Last week I came across an intriguing bit of research in the journal Social Psychological and Personality Science. While too much wallowing after heartbreak isn't a great idea, the study found that reflecting on a recent breakup can help speed the healing process.

See, Grace Larson, a graduate student in social psychology at Northwestern University, had been studying heartbreak for years when she began to wonder whether by asking study participants to rehash the painful details of their breakups, researchers like herself were hindering their recovery.

“ "Maybe science could tell me exactly what I needed to do to be able to move on and stop feeling so lost and sad and hurt."

So she rounded up 210 young volunteers who had recently experienced heartbreak, and had half of them come into the lab regularly to answer questions about their breakup over the course of nine weeks. The other half completed just two simple surveys, one at the beginning and one at the end of the study.

The first group fared better. Answering the researchers' questions helped these people better process their breakup and, Larson tells Shots, "it helped them develop a stronger sense of who they were as single people." That in turn helped them feel less lonely.

For me, Larson's research led to another revelation: that there existed a sizable body of research on how to cope with heartbreak. Maybe science could tell me exactly what I needed to do to be able to move on and stop feeling so lost and sad and hurt. So I put down my copy of Cosmo and began scouring psychological journals.

Heartache Really Is A Pain

“ "Under an MRI scanner, the brains of the heartsick can resemble the brains of those experiencing cocaine withdrawal."

First, I found out that heartache really does ache. In a 2011 study, researchers had participants look at photos of their ex-loves while monitoring these people's brain activity. They found that parts of the brain usually associated with physical pain had lit up. (Thankfully, another study found that taking a Tylenol might help buffer against such pain.)

That's why moving on isn't just a mental exercise; it's physical as well. Studies have found that people in long-term relationships tend to regulate each other's biological rhythms. A breakup can throw your entire physiology out of whack, disrupting your sleep, appetite, body temperature and heart rate. The stress of a divorce can compromise your immune system.

All this shows, Larson says, that "after a breakup, people are going to have to put in a little extra effort to keep themselves physically healthy."

Then you can start addressing the mental fallout.

"When a relationship ends, that really messes with your sense of who you are," Larson says. "You may think, 'Who am I now that I'm not Mike's or X or Y's girlfriend?' "

That's why, in Larson's study, talking about the breakup helped. "I think that it's possible that coming into the lab and answering these questions reminded them of their new status as singles," Larson says.

Shots - Health News Young And In Love? Thank Mom And Dad, At Least A Little

A growing body of research suggests that regaining a clear sense of self after a breakup is the key to moving on.

And though calmly reflecting on a breakup may help, dwelling on it doesn't, says David Sbarra, a psychologist at the University of Arizona who co-authored the study with Larson.

While it's tempting to think that getting back together will end the suffering, it may be better to adopt T-Swift's mantra of "We are never, ever, ever getting back together." While some couples are able to make up after a breakup, research suggests that on-again off-again couples tend to be less satisfied in their relationships.

Still, adapting to being alone after a breakup is not easy.

"So much of who our friends are and how we spend our time revolves around who we're dating or who we're married to," says Sbarra. "When the relationship ends, all of those variables get disrupted." Revisiting old friendships and interests can help, as can taking up new activities.

The Bad News And The Good

The bad news: Scientists have yet to find a quick and easy antidote for a broken heart. Recovering is going to take time, and it's probably going to suck.

In fact, one small study found that under an MRI scanner, the brains of the heartsick can resemble the brains of those experiencing cocaine withdrawal. The researchers theorize that this may explain why some of us feel — and act — a bit crazy after a bad breakup.

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Of course, it's best to at least try not to stalk your ex on Facebook or text him a bunch of times, Sbarra says, "because that's just going to bring you more pain." But blaming yourself for the breakup or for the way you're reacting to it isn't a good idea either.

"The only thing to do is to ride the emotion out," Sbarra says.

But there's good news, too: Getting over a breakup isn't going to be as painful as you probably think. While no one can say exactly how long it'll take you get over an ex, research shows that most people overestimate the amount of time it'll to recover.

“ "Your romantic relationships are supposed to be one of the fundamental sources of happiness and joy in your life. If a relationship isn't working, don't be afraid to break it off."

"I'm a little bit more pro-breakup than most people," says Gary Lewandowski, a psychologist at Monmouth University and co-founder of a blog called Science of Relationships.

Lewandowski's research backs up what Friedrich Nietzsche (and my mother and pretty much every pop song about breakups) have been saying all along: "That which doesn't kill us makes us stronger."

A 2007 study by Lewandowski his colleagues was one of the first to focus on the plus side of breakups. Most of the young adults who the researchers interviewed said the breakup had helped them learn and grow and that they felt more goal-oriented after splitting up.

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Coping with breakups can help people realize how resilient they are, Lewandowski says, and that can be empowering.

"I often tell my students, your romantic relationships are supposed to be one of the fundamental sources of happiness and joy in your life," he adds. "If a relationship isn't working, don't be afraid to break it off."

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Tax Time Gets New Ritual: Proof Of Health Insurance

NPR Health Blog - Tue, 01/13/2015 - 9:20am
Tax Time Gets New Ritual: Proof Of Health Insurance January 13, 2015 9:20 AM ET

Partner content from

Michelle Andrews

In addition to the normal thrills and chills of the income tax filing season, this year people will have the added excitement of figuring out how the health law figures in their 2014 taxes.

The good news is that for most folks the only change to their filing routine will be to check the box on their Form 1040 that says they had health insurance all year.

"Someone who had employer-based coverage or Medicaid or Medicare, that's all they have to do," says Tricia Brooks, a senior fellow at Georgetown University's Center for Children and Families.

But for others, there are several situations to keep in mind.

If you were uninsured for some or all of the year

If you had health insurance for only part of 2014 or didn't have coverage at all, it's a bit more complicated. In that case, you'll have to file Form 8965, which allows you to claim an exemption from the requirement to have insurance or calculate your penalty for the months that you weren't covered.

On page 2 of the instructions for Form 8965 you'll see a lengthy list of the coverage exemptions for which you may qualify. If your income is below the filing threshold ($10,150 for an individual in 2014), for example, you're exempt. Likewise if coverage was unaffordable because it would have cost more than 8 percent of your household income or you had a short coverage gap of less than three consecutive months.

Some of the exemptions have to be granted by the health insurance marketplace, but many can be claimed right on your tax return. The tax form instructions spell out where to claim each type of exemption.

If you do have to go to the marketplace to get an exemption, be aware that it may take two weeks or more to process the application. Act promptly if you want to avoid bumping up against the April 15 filing deadline, says Timothy Jost, a professor and specialist in health law at Washington and Lee University who is an expert on the health law.

If you don't qualify for a coverage exemption

If none of the exemptions apply to you, you'll owe a penalty of either $95 or 1 percent of your income above the tax filing threshold, whichever is greater. The penalty will be prorated if you had coverage for at least part of the year. The instructions for Form 8965 include a worksheet to calculate the amount of your penalty.

If you received a premium tax credit for a marketplace plan

Under the health law, people with incomes between 100 and 400 percent of the federal poverty level ($11,490 to $45,960 for an individual in 2013) could qualify for premium tax credits for 2014 coverage bought on the exchanges.

The marketplace determined the amount of premium tax credit people were eligible for based on their estimated income. At tax time those estimates will be reconciled against actual income. People whose income was lower than they estimated may have received too little in advance premium tax credits. They can claim the amount they're owed as a tax refund.

People whose income was higher than estimated and received too much in advance premium tax credits will generally have to pay back some or all of it.

If you bought a plan on the marketplace, you'll receive a Form 1095-A from your state marketplace by Jan. 31 that spells out how much your insurer received in advance premium tax credits. You'll use that information to complete Form 8962.

Assuming the information on the form is correct, "It should be easy to reconcile," says Judith Solomon, vice president for health policy at the Center on Budget and Policy Priorities. Tax software programs and tax preparers also should know how to make the calculations, she said.

Many lower income consumers and seniors can get free tax preparation assistance through the IRS Volunteer Income Tax Assistance and the Tax Counseling for the Elderly programs

Copyright 2015 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.
Categories: NPR Blogs

Imagining A Future When The Doctor's Office Is In Your Home

NPR Health Blog - Mon, 01/12/2015 - 5:12pm
Imagining A Future When The Doctor's Office Is In Your Home January 12, 2015 5:12 PM ET

Visitors check out wireless blood pressure monitors at the Consumer Electronics Show in Los Angeles.

Joe Klamar/AFP/Getty Images

Extracting medical care from the health care system is all too often an expensive exercise in frustration. Dr. Eric Topol says your smartphone could make it cheaper, faster, better and safer.

That's the gist of his new book, The Patient Will See You Now. Lots of people are bullish on the future of mobile health to transform health care, but Topol gets extra cred because of his major medical chops: Former head of cardiology at the Cleveland Clinic and present director of the Scripps Translations Science Institute in La Jolla, Calif.

We caught up with Topol during his book tour to ask him just what mobile, digital health care would be like. Here's an edited version of our conversation.

What got you excited about mobile health applications?

Back when I was at Cleveland Clinic, in 2000, I was contacted as a cardiologist from a company that wanted to be able to do your heart rhythm monitoring over the Internet. It was the first dedicated digital medical company. I thought that was very exciting. That opened my eyes to oh my gosh, there's a whole new world out there.

All Tech Considered Self-Tracking Gadgets That Play Doctor Abound At CES

The initial reaction was that's pretty zany, but there was also some genuine excitement. It wasn't ready yet, but the concept was highly attractive. Now you can have something smaller than a credit card and can get your heart rhythm monitoring through the phone, and it's FDA approved. You can buy it for $69 on Amazon, have it delivered to your door and have your rhythm monitored no matter where you are.

You've used that sort of phone-based heart rhythm monitor to diagnose people on airplane flights — twice. Now you're saying that a lot of the testing and monitoring that is done in hospitals would be better done at home. How would that work?

The hospital is an edifice we don't need except for intensive care units and the operating room. [Everything else] can be done more safely, more conveniently, more economically in the patient's bedroom.

Shots - Health News Take Your Medicine, Tap Your Phone And Collect A Prize

We made this unbelievable switch from inpatient surgery to outpatient, so many operations are done now as an outpatient. So we did adapt. You can now do a stent as an outpatient in an hour. So that's going to happen again. We're going not from inpatient to outpatient but inpatient to home. Hospitals are going to need to become data surveillance centers. The data is going to be coming from the community, from the region.

Won't a lot of people be left behind because they can't afford to do this or can't manage the systems?

We're talking about cheap stuff; smartphones you can get for $35 now from China. You have a cheap phone, you have mobile signal everywhere, pretty much, and you have very user friendly interfaces. My 93-year-old mother-in-law lives with us and she's on her iPad constantly.

It might be cheaper for us to give a smartphone and a service contract to people rather than to have them go to emergency rooms and be hospitalized; one day in the hospital is $4,500 in the U.S. I think the cost of that tradeoff is eventually going to be borne out.

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There are health care systems like Kaiser with a mobile app where you can access any part of your record, your labs, your chart notes, your hospital records. Organizations that don't share that though a mobile device are not going to make it.

Hospitals are not going to be thrilled with losing market share. How are these changes going to come about?

It's not going to happen from within the medical community; it has to be from external forces. All the big tech companies are getting into medicine — we have Google, Apple, Facebook, Salesforce.com. But the real innovation isn't coming from them, it's coming from the startups. There's one I love, this UCLA startup, they started this company to do X-rays through your phone. It's the selfie of the future.

Shots - Health News Patients Lead The Way As Medicine Grapples With Apps

We have to get the privacy security part cleaned up. And we also have to get the science analytics tuned up. We have to get a lot of validation, clinical trials. A lot of these have not gone though clinical trials; they're just attractive ideas that need to be proven.

Where do real live doctors fit into this world?

I am a regular cardiologist on Thursday; it's my clinical day, I love that. I'm going to continue to to advance this new model of care which is individualized and modern, but also never discounting the vital aspect of the human factor, human touch. Anyone who knows me as a doctor knows I have really close relations with patients; it's not this computer machine thing. I love practicing medicine and I'm going to continue doing it with that paramount objective.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Why OCD Is 'Miserable': A Science Reporter's Obsession With Contracting HIV

NPR Health Blog - Mon, 01/12/2015 - 2:07pm
Why OCD Is 'Miserable': A Science Reporter's Obsession With Contracting HIV January 12, 2015 2:07 PM ET Listen to the Story 37 min 23 sec   Additional Information: The Man Who Couldn't Stop

OCD and the True Story of a Life Lost in Thought

by David Adam

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If you have an obsessive but irrational fear, it would probably be pretty difficult for anyone to talk you out of it. Because irrational fears, by definition, aren't rational, which is one of the reasons having obsessive-compulsive disorder is such a nightmare.

For science reporter David Adam, he's obsessed with HIV.

"I grew up in the '80s when there was huge public information about the dangers of HIV," Adam tells Fresh Air's Terry Gross. "And a few years later, when I was at college, I was 18, 19 — I just started to worry obsessively that I was infected. Not that I had done anything particularly that would make me likely to become infected."

Adam says he knew his thinking was "ridiculous."

"I am an educated, reasonably scientifically literate person," he says. "And yet I have this irrational fear, which I recognize as being irrational and being foolish, and I perform compulsive behavior."

Adam's new book The Man Who Couldn't Stop chronicles his experiences and takes a wider look at how medical understanding and treatment of the disorder have changed over the years.

Adam has had OCD for 20 years. His fear that he will catch AIDS — in situations where it would be almost impossible for him to acquire HIV — has been quieted by OCD treatment he's received, but it hasn't gone away.

He's not alone when it comes to this disorder, he says, but that doesn't help with the agony.

"It's about the fourth most common mental illness and it affects pretty much everybody — men, women, children, adults, people of all cultures and all creeds and all races," he says. "And it's pretty miserable, let me tell you."

Interview Highlights

David Adam is a writer and editor at the journal Nature and was a special correspondent at the Guardian, writing about science, medicine and the environment.

Courtesy of Farrar, Straus and Giroux, LLC

On how Adam's obsession manifests itself

I scraped my heel down the back of a step in the public swimming baths in Manchester, and I became obsessed that there may have been blood on the step and so I wanted to check that. I then took a paper towel from near the sink and I pressed that to my bleeding ankle. I then became obsessed that there may have been blood on that paper towel, so I had to check on the other paper towels.

And so you get trapped in this loop where you're desperate for certainty and you can never get it — you're always checking. For example, I have a small cut on my thumb, right now, today, and I'm very aware of who I shake hands with, if they have a Band-Aid on their finger. I can spot a Band-Aid at 100 yards. I know this is ridiculous and yet a little, little part of me thinks that maybe they've got blood coming out of their wound and maybe it could get into my small cut on my thumb.

On how he repeatedly called the AIDS hotline

I hated myself for doing it and many times I would dial the number and then I would hang up before anyone answered. If someone answered, and it was a voice that I recognized, that's when I started to think, "Well, I better impersonate somebody else." Because ... I know now, that they were getting a lot of calls from people they called "the worried well" at the time. And they would say to people, "You already rung. We can't give you any more information. You need to accept it."

But what drives OCD, or at least it did in my case, was this constant need for that reassurance. ... It is humiliating, it's embarrassing, but humiliation and embarrassment were a price worth paying if you get that security, if you get that reassurance, if you get able to put your mind at rest.

On how his obsession with HIV affected (or didn't affect) his sex life

The only people who I told [about my OCD] were girlfriends ... because [sex] was an issue for me. You can have safe sex, but to be honest, [asking about someone's sexual health] is a rational question, and the OCD mind is not rational.

So I was just as worried about scraping my knee along the surface when I played soccer. I was just as worried about that — and I was still able to play soccer. You just get used to a level of constant anxiety. And the source of the anxiety almost becomes irrelevant.

“ 95 percent of people, when you ask them, have intrusive thoughts. ... Some people get an urge to jump from a high place, from a bridge or a high window. Some people get an urge just to attack people in the street. ... Some people get a really strange urge to shout out a swear word.

So I can't tell you that I was more worried about catching HIV from sex because I was so worried about catching it from everything else that it just blended into the background.

On intrusive thoughts

Intrusive thoughts are everywhere. Everybody, or 95 percent of people, when you ask them, have intrusive thoughts. ... A very common one is when you're waiting for the train ... and you hear it start to come, some people get an urge to jump in front of the train. Some people get an urge to jump from a high place, from a bridge or a high window. Some people get an urge just to attack people in the street or when you are in a very quiet place like a church or a library. Some people get a really strange urge to shout out a swear word. Those thoughts are everywhere and in most people they pass, but the reaction to them is usually, "Woah, where did that come from?" In OCD, what happens is that they tend to, for some reason, we treat them more seriously than other people.

So for example, the intrusive thought about stepping in front of a train, someone might have that thought and they're not suicidal at all and most people would [have the thought and think], "Well, that's a bit strange. Here's the train. I'll get on it and go to work." Some people, they might think, "Well, maybe I am suicidal, or maybe I do want to jump." And so what they do is, when the train comes, they just take a step back, they change their behavior because of the thought, and that's the slippery slope because very soon, rather than take one step back you'll take two steps back.

On what causes OCD

The honest answer is that we don't know, but there are some clues. So it seems to run in families, which suggests that there is properly some kind of genetic component, although it has been difficult to pin that down to any particular genes. Certainly there is a clinical, psychological explanation, which is if you have a certain mindset, then you are more likely to misinterpret the kind of thoughts that everybody has.

There is also a sense that there are particular parts of the brain, which can't be turned off in OCD. There's a very deep part of the brain called the basal ganglia, which holds patterns for instinctive behaviors — "run away," or "fight or flight" — and those can be activated and then usually have an alert and then you have the "all clear."

And it could be that in OCD the message to give the "all clear" doesn't get through properly and so you are reacting to a stimulus that isn't there anymore, which would explain the constant need to perform the compulsions.

On whether writing the book helped him

I think it helps ... With OCD, or at least my OCD, there are two negative effects. There's the primary negative effect, which is the anxiety caused by my irrational fear of HIV and that isn't going to be affected by knowledge. You can't outthink a thought disorder. Logic is no response to an irrational thought. And so I still get anxious about HIV in loads of different ways that I shouldn't.

But there's also a secondary effect of OCD. ... Imagine other mental illnesses and some physical illnesses where ... you're so aware that you have this thing, and with OCD you keep it secret, [so] it changes your relationships with people. It makes you think that you're living a lie, that you're not being honest with people, that you have this parallel narrative that, "If only I didn't have OCD, my life would be different and I would be having this very conversation in a different way..." All that kind of stuff.

That side of it has gone now because I'm talking about it; I'm being honest about it. Learning about the science and the history helped connect me to other people.

Read an excerpt of The Man Who Couldn't Stop

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Your Online Avatar May Reveal More About You Than You'd Think

NPR Health Blog - Mon, 01/12/2015 - 10:46am
Your Online Avatar May Reveal More About You Than You'd Think January 12, 201510:46 AM ET Alison Bruzek iStockphoto

My Nintendo Wii character, my Mii, looks a lot like me. She has the same haircut, the same skin tone and even the same eyebrow shape. And while my Mii plays tennis slightly better than I do, I designed her to be a real, virtual me (albeit with balls for hands).

But it turns out I might not have needed to mimic my appearance to let people know what I'm like.

Wanna be friends? Two of the avatars that people created for the study.

Katrina Fong

Your digital avatar gives away more hints about your personality than you might think, according to a study published Friday in the Personality and Social Psychology Bulletin. And that's true even if you craft your avatar to look completely different from you.

"Despite avatars being whatever an individual wants them to be ... that person's personality can come through and be communicated accurately to others," Katrina Fong, a Ph.D. student in psychology at York University and lead author of the study, tells Shots. "Who we are in real life does to some extent drive our choices in deciding how to represent ourselves online."

In particular, Fong refers to the Big Five personality traits: openness, conscientiousness, extroversion, agreeableness and neuroticism.

For example, those high on agreeableness are more likely to give their avatars features that would prompt others to befriend them, Fong found. People who reported themselves as more extroverted, more agreeable and more conscientious were more likely to be accurately predicted based on their avatar, while people who said they were more neurotic garnered less accurate predictions.

Fong's study looked at 99 students, including 50 men, who made an avatar using the site WeeWorld.com. Half were told the avatar should represent "who you really are," while half were told the avatar didn't need to look like them.

The participants could choose the sex, skin tone, facial features, head shape, hair, clothing and accessories of their online friend. Each student also took a personality test.

A different group of 209 students was then asked to examine the avatars and rate what they thought of the creator's personality, based on the same five traits, and if they would want to be friends with the creator.

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The raters accurately identified the creator's extroversion, agreeableness and neuroticism based on their avatar, even if the avatar didn't physically resemble the person. They couldn't, however, discern the person's openness or conscientiousness.

While it sounds surprising, it makes sense that an avatar can accurately convey someone's personality, says Kristine Nowak, an associate professor of communication at the University of Connecticut who was unaffiliated with the study. After all, it's something the user chose, as opposed to the body that they were born with and (short of major surgery) can't change.

All Tech Considered Pew: Gaming Is Least Welcoming Online Space For Women

Part of the reason raters could discern personality traits was due to certain features that creators gave their avatars, like open eyes.

When you meet someone in a crowded room at a party, you look at their eyes to determine their intentions, says Fong. Similarly, avatars with open eyes were more likely to be found agreeable and to make the rater want to be the creator's friend.

However, a neutral expression or any expression but a smile was less likely to make the rater want to be friends.

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Other traits, like an oval face, brown hair or a sweater, were also more likely to make the rater want to be friends. And if you're looking to make friends, black hair, short hair, a hat and sunglasses are all no-nos.

The avatar's sex also played a role in how the creator was perceived. Male avatars were viewed as less conscientious and less open to experience than female avatars.

Overall, the perceptions mirrored how we make assessments of people IRL (in real life). "You look at an avatar and ask, 'Who do you think is more likely to be friendly?' " says Fong.

"People pick up on just these little subtle cues. It's almost like in poker — you have a tell," says Robert Andrew Dunn, an assistant professor of communication at East Tennessee State University who studies avatars and identity.

Using avatars or images to represent a person is only becoming more and more popular with the rise of social media, says Dunn. And we're making judgments about them all the time. "When you go on Twitter and you see somebody that still has that egg avatar, what does that tell you about that person?"

All of which leads me to believe that while I may not be able to pick a winning doubles player based on his or her Mii, I can probably pick out the one who wants to be my friend.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

The Doctor Who Championed Hand-Washing And Briefly Saved Lives

NPR Health Blog - Mon, 01/12/2015 - 3:22am
The Doctor Who Championed Hand-Washing And Briefly Saved Lives January 12, 2015 3:22 AM ET Listen to the Story 7 min 17 sec  

This is the story of a man whose ideas could have saved a lot of lives and spared countless numbers of women and newborns' feverish and agonizing deaths.

You'll notice I said "could have."

The year was 1846, and our would-be hero was a Hungarian doctor named Ignaz Semmelweis.

Semmelweis was a man of his time, according to Justin Lessler, an assistant professor at Johns Hopkins School of Public Health.

Semmelweis considered scientific inquiry part of his mission as a physician.

De Agostini Picture Library/Getty Images

It was a time Lessler describes as "the start of the golden age of the physician scientist," when physicians were expected to have scientific training.

So doctors like Semmelweis were no longer thinking of illness as an imbalance caused by bad air or evil spirits. They looked instead to anatomy. Autopsies became more common, and doctors got interested in numbers and collecting data.

The young Dr. Semmelweis was no exception. When he showed up for his new job in the maternity clinic at the General Hospital in Vienna, he started collecting some data of his own. Semmelweis wanted to figure out why so many women in maternity wards were dying from puerperal fever — commonly known as childbed fever.

He studied two maternity wards in the hospital. One was staffed by all male doctors and medical students, and the other was staffed by female midwives. And he counted the number of deaths on each ward.

When Semmelweis crunched the numbers, he discovered that women in the clinic staffed by doctors and medical students died at a rate nearly five times higher than women in the midwives' clinic.

But why?

At Vienna General Hospital, women were much more likely to die after childbirth if a male doctor attended, compared to a midwife.

Josef and Peter Schafer/Wikipedia

Semmelweis went through the differences between the two wards and started ruling out ideas.

Right away he discovered a big difference between the two clinics.

In the midwives' clinic, women gave birth on their sides. In the doctors' clinic, women gave birth on their backs. So he had women in the doctors' clinic give birth on their sides. The result, Lessler says, was "no effect."

Then Semmelweis noticed that whenever someone on the ward died of childbed fever, a priest would walk slowly through the doctors' clinic, past the women's beds with an attendant ringing a bell. This time Semmelweis theorized that the priest and the bell ringing so terrified the women after birth that they developed a fever, got sick and died.

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So Semmelweis had the priest change his route and ditch the bell. Lessler says, "It had no effect."

By now, Semmelweis was frustrated. He took a leave from his hospital duties and traveled to Venice. He hoped the break and a good dose of art would clear his head.

When Semmelweis got back to the hospital, some sad but important news was waiting for him. One of his colleagues, a pathologist, had fallen ill and died. It was a common occurrence, according to Jacalyn Duffin, who teaches the history of medicine at Queen's University in Kingston, Ontario.

“ This was a revelation — childbed fever wasn't something only women in childbirth got sick from. It was something other people in the hospital could get sick from as well.

"This often happened to the pathologists," Duffin says. "There was nothing new about the way he died. He pricked his finger while doing an autopsy on someone who had died from childbed fever." And then he got very sick himself and died.

Semmelweis studied the pathologist's symptoms and realized the pathologist died from the same thing as the women he had autopsied. This was a revelation: Childbed fever wasn't something only women in childbirth got sick from. It was something other people in the hospital could get sick from as well.

But it still didn't answer Semmelweis' original question: "Why were more women dying from childbed fever in the doctors' clinic than in the midwives' clinic?"

Duffin says the death of the pathologist offered him a clue.

"The big difference between the doctors' ward and the midwives' ward is that the doctors were doing autopsies and the midwives weren't," she says.

So Semmelweis hypothesized that there were cadaverous particles, little pieces of corpse, that students were getting on their hands from the cadavers they dissected. And when they delivered the babies, these particles would get inside the women who would develop the disease and die.

Shots - Health News Schoolchildren Who Add Hand Sanitizer To Washing Still Get Sick

If Semmelweis' hypothesis was correct, getting rid of those cadaverous particles should cut down on the death rate from childbed fever.

So he ordered his medical staff to start cleaning their hands and instruments not just with soap but with a chlorine solution. Chlorine, as we know today, is about the best disinfectant there is. Semmelweis didn't know anything about germs. He chose the chlorine because he thought it would be the best way to get rid of any smell left behind by those little bits of corpse.

“ Semmelweis didn't know anything about germs. He chose the chlorine because he thought it would be the best way to get rid of any smell left behind by those little bits of corpse.

And when he imposed this, the rate of childbed fever fell dramatically.

What Semmelweis had discovered is something that still holds true today: Hand-washing is one of the most important tools in public health. It can keep kids from getting the flu, prevent the spread of disease and keep infections at bay.

You'd think everyone would be thrilled. Semmelweis had solved the problem! But they weren't thrilled.

For one thing, doctors were upset because Semmelweis' hypothesis made it look like they were the ones giving childbed fever to the women.

And Semmelweis was not very tactful. He publicly berated people who disagreed with him and made some influential enemies.

Eventually the doctors gave up the chlorine hand-washing, and Semmelweis — he lost his job.

“ Even today, convincing health care providers to take hand washing seriously is a challenge.

Semmelweis kept trying to convince doctors in other parts of Europe to wash with chlorine, but no one would listen to him.

Even today, convincing health care providers to take hand-washing seriously is a challenge. Hundreds of thousands of hospital patients get infections each year, infections that can be deadly and hard to treat. The Centers for Disease Control and Prevention says hand hygiene is one of the most important ways to prevent these infections.

Over the years, Semmelweis got angrier and eventually even strange. There's been speculation he developed a mental condition brought on by possibly syphilis or even Alzheimer's. And in 1865, when he was only 47 years old, Ignaz Semmelweis was committed to a mental asylum.

The sad end to the story is that Semmelweis was probably beaten in the asylum and eventually died of sepsis, a potentially fatal complication of an infection in the bloodstream — basically, it's the same disease Semmelweis fought so hard to prevent in those women who died from childbed fever.

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